Denise and her blog
Expectancy is Worldwide!
Did you know that Expectancy is unique, worldwide, in providing university-level professional and academic courses specifically for midwives on the safe use of complementary therapies in pregnancy, birth and the postnatal period? Expectancy has been offering complementary therapy courses for almost 22 years, in the UK and overseas. I’ve helped NHS midwives to implement aromatherapy, clinical reflexology and moxibustion for breech presentation. I’ve encouraged several hundred midwives to train in both complementary therapies and business studies so they can start their own private practices. And I’ve had the great pleasure of travelling to many countries around the world, including Japan, Hong Kong, Taiwan, China, Iceland, Spain, Norway, Canada and elsewhere, to train midwives in various therapies. I’m immensely proud of the midwives who join our Expectancy Community and who follow their dreams of providing the best possible care to their clients.
A Place For Complementary Therapies
One of the most important principles behind everything I teach at Expectancy is safety and professional accountability.
Complementary therapies in midwifery can sometimes attract scepticism, particularly when they are associated with discussions around physiological or “natural” birth.
That’s why our programmes place such a strong emphasis on evidence-based practice, safety frameworks and professional debate.
Midwives need to be able to explain why they are using a therapy, understand the safety considerations, and practise within the professional boundaries set out in the Nursing and Midwifery Council Code.
This allows midwives to confidently discuss their practice with colleagues, managers and parents - grounded in professional accountability and the best evidence available.
Complementary therapies should never sit outside professional practice.
They should sit within it.
What About Midwives Who Choose To Work Outside Mainstream Midwifery?
I had a great time recently at the Royal College of Midwives’ education and research conference in London. It was good to meet up with friends and colleagues and to debate current issues around midwifery and maternity care. As you might expect, there was a lot of discussion about the ongoing investigations into maternity service problems, and of course, everyone had their views on possible solutions. There were several presentations on equity, diversity and inclusivity and several on the increasing use of artificial intelligence in midwifery education. There was also much talk of the difficulties facing students trying to achieve their required 40 physiological births and, of course, the ongoing problem of intervention in childbirth.
However, it was disappointing to see that the RCM and all the speakers focused only on NHS clinical midwifery or research and on education provided by universities. There was no acknowledgement at all of the growing number of registered midwives choosing to work outside “the system” – independent midwives offering full birth services, midwifery educators providing specialist post-registration training, midwives in private practice offering antenatal education, complementary therapies, tongue tie division and other maternity-related services, midwives working for charities such as BPAS, or for companies that design digital programmes for maternity care or midwives engaged by private companies to undertake research or very senior midwives with national and international reputations offering consultancy services.
This lack of recognition that midwives can work in many ways in diverse settings is disrespectful to those of us who are self-employed. There is no apparent appreciation that being a registered midwife entitles you to work anywhere in any setting in any field of midwifery as defined by the WHO and ICM, from preconception care and fertility through pregnancy, birth and the postnatal period up to one year after birth. It is as if those who work outside mainstream clinical or educational organisations are “persona non grata” and disregarded in favour of the majority. Is this not a form of discrimination in its own right?
I raised this point on at least two occasions during the conference, including in sessions at which there were several midwifery educators or clinicians who have retired from the university sector or NHS and who are now working in a freelance consultancy capacity. There is an inherent undercurrent of dismissal of those who leave the NHS or higher education systems (even when some of those have given years of service and reached retirement age but who choose to continue working). It is almost as if our treacherous behaviour somehow undermines the value of the NHS or HEIs and that by doing so, we come up lacking credibility. (I remember, over twenty years ago when I left the university to set up Expectancy, a colleague from another university implying that I could not possibly be as good a lecturer as before now I had dared to go it alone.)
Then of course, there is the small matter of freelance midwives actually charging for our services. Chatting with colleagues about the various investigations currently in the news, one fairly senior midwife commented on the apparent hefty fees one authority was “raking in” – it was not actually a large amount that was quoted - but to an NHS midwife on a salary it obviously seemed like a small fortune. Yet, do NHS midwives work for nothing? Do they offer their services pro bono? Absolutely not – even though they may work plenty of hours of unpaid overtime. It seems, however, that actually having to charge for your services (rather than being paid a salary) is not de rigeur, not in keeping with the philosophy of our free-at-the-point-of-access healthcare system.
Whilst I completely understand that there are other priorities at present, including Ockenden reviews, the Amos report, ever-increasing intervention rates in childbirth, lack of resources, including staff and a dwindling (retiring) workforce, no jobs for newly qualified midwives and more, it is imperative that our colleagues and the organisations that affect our profession recognises that the way midwives choose to work is changing – and the way expectant parents want to receive care is also changing and they are prepared to pay for services they cannot find in the NHS. Let’s have a shout out for all those wonderful midwives who are working incredibly hard outside the system – in clinical midwifery, in education and in other areas in which being a registered midwife is a requirement.
Working with The Midwives at Liverpool Woman's NHS Foundation Trust
I’ve just returned from a wonderful few days in Liverpool working with the midwives at Liverpool Women's NHS Foundation Trust.
This was my second visit to provide Expectancy’s 3-day course on Aromatherapy and Acupressure for Postdates Pregnancy, helping midwives expand a specialist clinic designed to support women preparing for birth and potentially reduce the need for induction.
It was fantastic to see such enthusiasm from the 20 midwives attending the training.
Over the three days we explored:
• Safe use of aromatherapy at term and during labour
• Massage techniques for labour support
• Reflex zone therapy and its diagnostic insights
• Acupressure points to support cervical ripening and labour onset
But the highlight for me was visiting the birth preparation clinic in the midwife-led unit and seeing how the service is being delivered in practice.
The clinic is proving hugely popular, and early audit findings suggest that more women are going into labour spontaneously and requiring fewer interventions.
Most importantly, the midwives are delivering the service with a strong foundation in safety and professional criteria, exactly as we teach on the course.
It was a pleasure to spend time with such a dedicated team and to see the impact they are already having for the women they support.
And now… time to pack my bags for Yorkshire for the next course.
How Things Have Changed In Midwifery
I’ve been a midwife for almost 50 years, starting in the mid-70s at a time when it was all very “Call the Midwife”. We didn’t talk about “physiological birth” or “intervention” – women just got on with being pregnant and giving birth, then adapting to motherhood. Here are a few of the things that have changed in the last 50 years (and how I miss some, but not all of them!)
- The midwife was truly the expert in pregnancy, birth and postnatal care of mother and baby. Once, as a community midwife rushing to a home birth, I arrived to find the GP literally holding the baby’s head in the vagina and stating “I was waiting for you, Sister”!
- Midwives were respected pillars of the community and women always deferred to their advice (they did what they were told!)
- Almost all midwives had trained as nurses and then took additional training – I was in the last group of the one-year post-nursing students
- Students always got their required numbers of normal births; observing the required number of complicated births was more difficult
- Doctors were absolutely only called in when progress deviated from normal, which was hardly ever; and GPs were much more actively involved in maternity care, as they knew all their patients and cared for the whole family
- It was quite common for midwives to deliver breech babies, rarely was the obstetrician called
- Women either got pregnant – or they didn’t – there was no fertility treatment (and still variable availability of family planning / contraception services)
- The process of becoming pregnant was never discussed – what happened before reporting to antenatal clinic was in “another life”
- All expectant mothers were called “Mrs” – surveys showed this was their preference, as unmarried women didn’t want to be identified
- Most women didn’t work so could prepare for birth, relax and focus on their new baby without getting completely over-tired; other women in the community always helped out
- Antenatal education (parentcraft) classes involved lectures followed by relaxation sessions (the original “hypnobirthing”); there was usually only one class for fathers, often led by the (male) obstetrician, after which the men would all go down to the pub
- There were very few inductions, even fewer Caesareans, no CTG monitors (they started to be used in the late 70s, very sparingly).
- Men had only recently started to be welcomed into the birth room; most paced the floors outside the room or went outside to smoke (and patients were still allowed to smoke in the wards!)
- We had three types of inhalational analgesia – Entonox, Trilene and another (I can’t remember the name as it was just becoming obsolete when I started); pethidine was only used if absolutely necessary - and there were virtually no epidurals
- Routine enemas and vulval shaving was normal; episiotomy was only used as a last resort – and was often done as a midline incision, not mediolateral
- Community midwives conducted home births on their own, with the woman in left lateral position and her upper leg balanced over the midwife’s shoulder; if problems arose, we called out the “flying squad”
- Breastfeeding was the norm; stilboestrol was often given to dry up the milk of mothers who didn’t want to breastfeed (rare) or whose babies had died; stilboestrol was banned some years later as it was found to be carcinogenic
- There were no disposable nappies, we used terry towelling, put to soak in Milton after use and then washed in the twin tub washing machine and wrung out by a mangle at the top of the machine
- Postnatal visits by midwives were done twice a day up to day 3, daily up to day 10, then weekly until 28 days, or longer if the cord had not separated and the umbilicus healed; women waited for the midwife and would not have dared to take the baby out before 10 days!
- The health visitor took over care at 28 days and mothers were encouraged to go to the baby clinic weekly for weighing the baby, feeding, baby care and immunisation advice; the clinic was a place for women to meet and chat, have a cup of tea and get their vitamins
- Most women cared fulltime for their children until at least school age, usually longer; women rarely returned to work after birth, especially as they often got pregnant again quite quickly
- Postnatal depression was not heard of, or at least never discussed – you just got on with caring for the baby, cooking food, cleaning and putting up with your lot
Would you ever think to ask about pets when discussing essential oils? 🐾
It might sound unrelated - but it isn’t.
Cats lack the enzyme needed to metabolise essential oils safely, which means aromatherapy oils should not be used around them at all - even in litter trays.
As midwives using or teaching complementary therapies, safety doesn’t stop at pregnancy. It extends into the whole home environment.
Sometimes the smallest details are part of the safest practice.
Previous articles
Expectancy is Worldwide!
A Place For Complementary Therapies
What About Midwives Who Choose To Work Outside Mainstream Midwifery?
Working with The Midwives at Liverpool Woman's NHS Foundation Trust
How Things Have Changed In Midwifery
Would you ever think to ask about pets when discussing essential oils? 🐾
Praise for Liverpool Women’s Hospital’s Pre-Birth and Postdates Pregnancy Service
FAQs
Safety and Storage of Essential Oils
Complementary Therapies Aren’t About “doing more ”
